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9662_32	See also List of former monarchies List of current monarchies List of current monarchs of sovereign states Non-sovereign Monarchy References Monarchies
9663_0	The Basilidians or Basilideans were a Gnostic sect founded by Basilides of Alexandria in the 2nd century. Basilides claimed to have been taught his doctrines by Glaucus, a disciple of St. Peter, though others stated he was a disciple of the Simonian Menander. Of the customs of the Basilidians, we know no more than that Basilides enjoined on his followers, like Pythagoras, a silence of five years; that they kept the anniversary of the day of the baptism of Jesus as a feast day and spent the eve of it in reading; that their master told them not to scruple eating things offered to idols. The sect had three grades – material, intellectual and spiritual – and possessed two allegorical statues, male and female. The sect's doctrines were often similar to those of the Ophites and later Jewish Kabbalism.
9663_1	Basilidianism survived until the end of the 4th century as Epiphanius knew of Basilidians living in the Nile Delta. It was however almost exclusively limited to Egypt, though according to Sulpicius Severus it seems to have found an entrance into Spain through a certain Mark from Memphis. St. Jerome states that the Priscillianists were infected with it. Cosmogony of Hippolytus
9663_2	The descriptions of the Basilidian system given by our chief informants, Irenaeus (Adversus Haereses) and Hippolytus (Philosophumena), are so strongly divergent that they seem to many quite irreconcilable. According to Hippolytus, Basilides was apparently a pantheistic evolutionist; and according to Irenaeus, a dualist and an emanationist. Historians such as Philip Shaff have the opinion that "Irenaeus described a form of Basilidianism which was not the original, but a later corruption of the system. On the other hand, Clement of Alexandria surely, and Hippolytus, in the fuller account of his Philosophumena, probably drew their knowledge of the system directly from Basilides' own work, the Exegetica, and hence represent the form of doctrine taught by Basilides himself".
9663_3	The fundamental theme of the Basilidian system is the question concerning the origin of evil and how to overcome it. A cosmographical feature common to many forms of Gnosticism is the idea that the Logos Spermatikos is scattered into the sensible cosmos, where it is the duty of the Gnostics, by whatever means, to recollect these scattered seed-members of the Logos and return them to their proper places (cf. the Gospel of Eve). "Their whole system," says Clement, "is a confusion of the Panspermia (All-seed) with the Phylokrinesis (Difference-in-kind) and the return of things thus confused to their own places."
9663_4	Creation According to Hippolytus, Basilides asserted the beginning of all things to have been pure nothing. He uses every device of language to express absolute nonentity. Nothing then being in existence, "not-being God" willed to make a not-being world out of not-being things. This not-being world was only "a single seed containing within itself all the seed-mass of the world," as the mustard seed contains the branches and leaves of the tree. Within this seed-mass were three parts, or sonships, and were consubstantial with the not-being God. This was the one origin of all future growths; these future growths did not use pre-existing matter, but rather these future growths came into being out of nothing by the voice of the not-being God. First sonship Part subtle of substance. The first part of the seed-mass burst through and ascended to the not-being God.
9663_5	Second sonship Part coarse of substance. The second part of the seed-mass to burst forth could not mount up of itself, but it took to itself as a wing of the Holy Spirit, each bearing up the other with mutual benefit. But when it came near the place of the first part of the seed-mass and the not-being God, it could take the Holy Spirit no further, it not being consubstantial with the Holy Spirit. There the Holy Spirit remained, as a firmament dividing things above the world from the world itself below.
9663_6	Third sonship and the Great Archon Part needing purification. From the third part of the seed-mass burst forth into being the Great Archon, "the head of the world, a beauty and greatness and power that cannot be uttered." He too ascended until he reached the firmament which he supposed to be the upward end of all things. There he "made to himself and begat out of the things below a son far better and wiser than himself". Then he became wiser and every way better than all other cosmical things except the seed-mass left below. Smitten with wonder at his son's beauty, he set him at his right hand. "This is what they call the Ogdoad, where the Great Archon is sitting." Then all the heavenly or ethereal creation, as far down as the moon, was made by the Great Archon, inspired by his wiser son.
9663_7	Another Archon arose out of the seed-mass, inferior to the first Archon, but superior to all else below except the seed-mass; and he likewise made to himself a son wiser than himself, and became the creator and governor of the aerial world. This region is called the Hebdomad. On the other hand, all these events occurred according to the plan of the not-being God. Gospel The Basilidians believed in a very different gospel than orthodox Christians. Hippolytus summed up the Basilidians' gospel by saying: "According to them the Gospel is the knowledge of things above the world, which knowledge the Great Archon understood not: when then it was shewn to him that there exists the Holy Spirit, and the [three parts of the seed-mass] and a God Who is the author of all these things, even the not-being One, he rejoiced at what was told him, and was exceeding glad: this is according to them the Gospel."
9663_8	That is, the Basilidians believed from Adam until Moses the Great Archon supposed himself to be God alone, and to have nothing above him. But it was thought to enlighten the Great Archon that there were beings above him, so through the Holy Spirit the Gospel was conveyed to the Great Archon. First, the son of the Great Archon received the Gospel, and he in turn instructed the Great Archon himself, by whose side he was sitting. Then the Great Archon learned that he was not God of the universe, but had above him yet higher beings; and confessed his sin in having magnified himself. From him the Gospel had next to pass to the Archon of the Hebdomad. The son of the Great Archon delivered the Gospel to the son of the Archon of the Hebdomad. The son of the Archon of the Hebdomad became enlightened, and declared the Gospel to the Archon of the Hebdomad, and he too feared and confessed.
9663_9	It remained only that the world should be enlightened. The light came down from the Archon of the Hebdomad upon Jesus both at the Annunciation and at the Baptism so that He "was enlightened, being kindled in union with the light that shone on Him". Therefore, by following Jesus, the world is purified and becomes most subtle, so that it can ascend by itself. When every part of the sonship has arrived above the Limitary Spirit, "then the creation shall find mercy, for till now it groans and is tormented and awaits the revelation of the sons of God, that all the men of the sonship may ascend from hence". When this has come to pass, God will bring upon the whole world the Great Ignorance, that everything may like being the way it is, and that nothing may desire anything contrary to its nature. "And in this wise shall be the Restoration, all things according to nature having been founded in the seed of the universe in the beginning, and being restored at their due seasons."
9663_10	Christ As for Jesus, other than a different account of the Nativity, the Basilidians believed in the events of Jesus' life as they are described in the Gospels. They believed the crucifixion was necessary, because by the destruction of Jesus' body the world could be restored. Ethics According to Clement of Alexandria, the Basilidians taught faith was a natural gift of understanding bestowed upon the soul before its union with the body and which some possessed and others did not. This gift is a latent force which only manifests its energy through the coming of the Saviour.
9663_11	Sin was not the results of the abuse of free will, but merely the outcome of an inborn evil principle. All suffering is punishment for sin; even when a child suffers, this is the punishment of the inborn evil principle. The persecutions Christians underwent had therefore as sole object the punishment of their sin. All human nature was thus vitiated by the sinful; when hard pressed Basilides would call even Christ a sinful man, for God alone was righteous. Clement accuses Basilides of a deification of the Devil, and regards as his two dogmas that of the Devil and that of the transmigration of souls.
9663_12	Cosmogony of Irenaeus and Epiphanius In briefly sketching this version of Basilidianism, which most likely rests on later or corrupt accounts, our authorities are fundamentally two, Irenaeus and the lost early treatise of Hippolytus; both having much in common, and both being interwoven together in the report of Epiphanius. The other relics of the Hippolytean Compendium are the accounts of Philaster (32), and the supplement to Tertullian (4).
9663_13	Creation At the head of this theology stood the Unbegotten, the Only Father. From Him was born or put forth Nûs, and from Nûs Logos, from Logos Phronesis, from Phronesis Sophia and Dynamis, from Sophia and Dynamis principalities, powers, and angels. This first set of angels first made the first heaven, and then gave birth to a second set of angels who made a second heaven, and so on till 365 heavens had been made by 365 generations of angels, each heaven being apparently ruled by an Archon to whom a name was given, and these names being used in magic arts. The angels of the lowest or visible heaven made the earth and man. They were the authors of the prophecies; and the Law in particular was given by their Archon, the God of the Jews. He being more petulant and wilful than the other angels (ἰταμώτερον καὶ αὐθαδέστερον), in his desire to secure empire for his people, provoked the rebellion of the other angels and their respective peoples. Christ
9663_14	Then the Unbegotten and Innominable Father, seeing what discord prevailed among men and among angels, and how the Jews were perishing, sent His Firstborn Nûs, Who is Christ, to deliver those Who believed on Him from the power of the makers of the world. "He," the Basilidians said, "is our salvation, even He Who came and revealed to us alone this truth." He accordingly appeared on earth and performed mighty works; but His appearance was only in outward show, and He did not really take flesh. It was Simon of Cyrene that was crucified; for Jesus exchanged forms with him on the way, and then, standing unseen opposite in Simon's form, mocked those who did the deed (this is starkly contradicted by Hippolytus' view of the Basilidians). But He Himself ascended into heaven, passing through all the powers, till He was restored to the presence of His own Father. Abrasax
9663_15	The two fullest accounts, those of Irenaeus and Epiphanius, add by way of appendix another particular of the antecedent mythology; a short notice on the same subject being likewise inserted parenthetically by Hippolytus. The supreme power and source of being above all principalities and powers and angels (such is evidently the reference of Epiphanius's αὐτῶν: Irenaeus substitutes "heavens," which in this connexion comes to much the same thing) is Abrasax, the Greek letters of whose name added together as numerals make up 365, the number of the heavens; whence, they apparently said, the year has 365 days, and the human body 365 members. This supreme Power they called "the Cause" and "the First Archetype," while they treated as a last or weakest product this present world as the work of the last Archon. It is evident from these particulars that Abrasax was the name of the first of the 365 Archons, and accordingly stood below Sophia and Dynamis and their progenitors; but his position is
9663_16	not expressly stated, so that the writer of the supplement to Tertullian had some excuse for confusing him with "the Supreme God."
9663_17	Precepts On these doctrines, various precepts are said by the Basilidians' opponents to have been founded. Antinomianism When Philaster (doubtless after Hippolytus) tells us in his first sentence about Basilides that "he violated the laws of Christian truth by making an outward show and discourse concerning the Law and the Prophets and the Apostles, but believing otherwise," the reference is probably revealing an antinomian sentiment among the Basilidians. The Basilidians considered themselves to be no longer Jews, and to have become more than Christians. Repudiation of martyrdom was naturally accompanied by indiscriminate use of things offered to idols. And from there the principle of indifference is said to have been carried so far as to sanction promiscuous immorality. Magic
9663_18	Among the later followers of Basilides, magic, invocations, "and all other curious arts" played a part. The names of the rulers of the several heavens were handed down as a weighty secret, which was a result of the belief that whoever knew the names of these rulers would after death pass through all the heavens to the supreme God. In accordance with this, Christ also, in the opinion of these followers of Basilides, was in the possession of a mystic name (Caulacau) by the power of which he had descended through all the heavens to Earth, and had then again ascended to the Father. Redemption, accordingly, could be conceived as the revelation of mystic names. Whether Basilides himself had already given this magic tendency to Gnosticism cannot be decided.
9663_19	A reading taken from the inferior MSS. of Irenaeus has added the further statement that they used "images"; and this single word is often cited in corroboration of the popular belief that the numerous ancient gems on which grotesque mythological combinations are accompanied by the mystic name ΑΒΡΑΣΑΞ were of Basilidian origin. It has been shown that there is little tangible evidence for attributing any known gems to Basilidianism or any other form of Gnosticism, and that in all probability the Basilidians and the pagan engravers of gems alike borrowed the name from some Semitic mythology. No attempts of critics to trace correspondences between the mythological personages, and to explain them by supposed condensations or mutilations, have attained even plausibility.
9663_20	Martyrdom The most distinctive is the discouragement of martyrdom, which was made to rest on several grounds. To confess the Crucified was called a token of being still in bondage to the angels who made the body, and it was condemned especially as a vain honour paid not to Christ, Who neither suffered nor was crucified, but to Simon of Cyrene. The contempt for martyrdom, which was perhaps the most notorious characteristic of the Basilidians, would find a ready excuse in their master's speculative paradox about martyrs, even if he did not discourage martyrdom himself. Relationship to Judaism According to both Hippolytus and Irenaeus, the Basilidians denied that the God of the Jews was the supreme God. According to Hippolytus, the God of the Jews was the Archon of the Hebdomad, which was inferior to the Great Archon, the Holy Spirit, the seed-mass (threefold sonship), and the not-being God.
9663_21	According to Irenaeus, the Basilidians believed the God of the Jews was inferior to the 365 sets of Archons above him, as well as the powers, principalities, Dynamis and Sophia, Phronesis, Logos, Nûs, and finally the Unbegotten Father. Resurrection of the body It is hardly necessary to add that they expected the resurrection of the soul alone, insisting on the natural corruptibility of the body. Secrecy Their discouragement of martyrdom was one of the secrets which the Basilidians diligently cultivated, following naturally on the supposed possession of a hidden knowledge. Likewise, their other mysteries were to be carefully guarded, and disclosed to "only one out of 1000 and two out of 10,000."
9663_22	The silence of five years which Basilides imposed on novices might easily degenerate into the perilous dissimulation of a secret sect, while their exclusiveness would be nourished by his doctrine of the Election; and the same doctrine might further after a while receive an antinomian interpretation.
9663_23	Later Basilidianism Irenaeus and Epiphanius reproach Basilides with the immorality of his system, and Jerome calls Basilides a master and teacher of debaucheries. It is likely, however, that Basilides was personally free from immorality and that this accusation was true neither of the master nor of some of his followers. However, imperfect and distorted as the picture may be, such was doubtless in substance the creed of Basilidians not half a century after Basilides had written. In this and other respects our accounts may possibly contain exaggerations; but Clement's complaint of the flagrant degeneracy in his time from the high standard set up by Basilides himself is unsuspicious evidence, and a libertine code of ethics would find an easy justification in such maxims as are imputed to the Basilidians.
9663_24	Two misunderstandings have been specially misleading. Abrasax, the chief or Archon of the first set of angels, has been confounded with "the Unbegotten Father," and the God of the Jews, the Archon of the lowest heaven, has been assumed to be the only Archon recognized by the later Basilidians, though Epiphanius distinctly implies that each of the 365 heavens had its Archon. The mere name "Archon" is common to most forms of Gnosticism. Basilidianism seems to have stood alone in appropriating Abrasax; but Caulacau plays a part in more than one system, and the functions of the angels recur in various forms of Gnosticism, and especially in that derived from Saturnilus. Saturnilus likewise affords a parallel in the character assigned to the God of the Jews as an angel, and partly in the reason assigned for the Saviour's mission; while the Antitactae of Clement recall the resistance to the God of the Jews inculcated by the Basilidians.
9663_25	Other "Basilidian" features appear in the Pistis Sophia, viz. many barbaric names of angels (with 365 Archons, p. 364), and elaborate collocations of heavens, and a numerical image taken from (p. 354). The Basilidian Simon of Cyrene apparently appears in the Second Treatise of the Great Seth, where Jesus says: "it was another, Simon, who bore the cross on his shoulder. It was another upon whom they placed the crown of thorns ... And I was laughing at their ignorance."
9663_26	History
9663_27	There is no evidence that the sect extended itself beyond Egypt; but there it survived for a long time. Epiphanius (about 375) mentions the Prosopite, Athribite, Saite, and "Alexandriopolite" (read Andropolite) nomes or cantons, and also Alexandria itself, as the places in which it still throve in his time, and which he accordingly inferred to have been visited by Basilides. All these places lie on the western side of the Delta, between Memphis and the sea. Nearer the end of the 4th century, Jerome often refers to Basilides in connexion with the hybrid Priscillianism of Spain, and the mystic names in which its votaries delighted. According to Sulpicius Severus this heresy took its rise in "the East and Egypt"; but, he adds, it is not easy to say "what the beginnings were out of which it there grew" (quibus ibi initiis coaluerit). He states, however, that it was first brought to Spain by Marcus, a native of Memphis. This fact explains how the name of Basilides and some dregs of his
9663_28	disciples' doctrines or practices found their way to so distant a land as Spain, and at the same time illustrates the probable hybrid origin of the secondary Basilidianism itself.
9663_29	Texts Basilidian works are named for the founder of their school, Basilides (132–? AD). These works are mainly known to us through the criticisms of one of his opponents, Irenaeus in his work Adversus Haereses. The other pieces are known through the work of Clement of Alexandria: The Octet of Subsistent Entities (Fragment A) The Uniqueness of the World (Fragment B) Election Naturally Entails Faith and Virtue (Fragment C) The State of Virtue (Fragment D) The Elect Transcend the World (Fragment E) Reincarnation (Fragment F) Human Suffering and the Goodness of Providence (Fragment G) Forgivable Sins (Fragment H) Footnotes References See also Fathers of Christian Gnosticism Gnosticism History of Gnosticism List of Gnostic sects Religious organizations established in the 2nd century Gnosticism 2nd-century establishments in Egypt 2nd century in Egypt Christian organizations established in the 2nd century Denial of the crucifixion of Jesus
9664_0	The Stadt- und Kreissparkasse Leipzig ("City and Regional Saving Bank of Leipzig") is a German public bank, a type of savings bank, based in Leipzig, Saxony. It is one of the largest financial institutions in the new German Länder. Organizational structure The Sparkasse Leipzig is a trustee institution under public law. Carrier is the Sparkassenzweckverband für die Stadt- und Kreissparkasse Leipzig and the Land Nordsachsen. The Savings Bank is a member of the East German Savings Bank Association (Ostdeutscher Sparkassenverband). The legal basis of the credit institution is the savings bank law of the Federal State of Saxony and the Statute of the Sparkasse. The management bodies of the savings bank are the board of directors and the executive board. The chairman of the board is the Leipzig Mayor Burkhard Jung. The executive chairman is Harald Langenfeld. Private Clients Management Board is Martin Bücher. Corporate board is Andreas Koch. Andreas Nüdling is deputy member.
9664_1	Business strategy and business success The Sparkasse Leipzig is the third largest savings bank in the new Länder after the Ostsächsische Sparkasse Dresden and the Mittelbrandenburgische Sparkasse. It is the market leader in retail banking, as well as in corporate and business customers of their business area and works together with business of Sachsen Bank, der LBS Ostdeutsche Landesbausparkasse AG, der Sparkassen-Versicherung Sachsen und der DekaBank. Its business area comprises the city of Leipzig, the Nordsachsen and Altlandkreis Leipziger Land for a size of approximately 3,085 square kilometers. The Sparkasse Leipzig had total assets for 8.902 billion euros and customer deposits for 7.153 billion euros in the fiscal year 2014 . According to the Savings Bank Ranking 2014, it is by total assets ranked 18th; it maintains 135 branches and employs 1,663 staff.
9664_2	History The savings bank opened in 1826 not far from the present-day headquarters premises at Löhrs Carré. Influential citizens of the city had suggested the establishment of an institution, which should allow the interest-bearing and secure investment of funds. Social commitment As a public institution, the Sparkasse Leipzig is committed to its business area. In addition to the Foundation (Stiftung) it has a Savings Bank Museum and a Kunsthalle, granted an insight into its collection of works of the New Leipzig School. In addition, the bank acts as a partner of associations and institutions, thus demonstrating its support for the common good.
9664_3	The Sparkasse Leipzig Foundation Media Foundation of Sparkasse Leipzig The main purpose of the Media Foundation is to promote the education and training of young people in the field of media. These include the awarding of merit scholarships, for example in the context of the Leipzig Media Prize, targeted project funding and the organization of events on political education, about to commemorate the fall of 1989 in Leipzig.
9664_4	Cultural and Environmental Foundation of Sparkasse Leipzig Leipziger Land To mark its 175th anniversary in 2001, the Sparkasse Leipzig decided to create the Cultural and Environmental Foundation Leipziger Land. The work of the Foundation was presented in October 2001 in a ceremony to the public. The Foundation deals with the history of the former district of Leipziger Land, nature conservation and landscape conservation, environmental protection and the training of young people from this region. The promotion of cultural interests of the literature on performing and visual arts to heritage conservation are also among the tasks of the Foundation.
9664_5	Sparkassenstiftung for the region Torgau-Oschatz
9664_6	The purpose of this foundation is to promote culture and heritage conservation within the territory of the Torgau-Oschatz Altlandkreises from the proceeds of the endowment. The foundation's aims are realized through the promotion of music, literature, performing and visual arts and their institutions. In addition, the Foundation is committed through the acquisition and management of works of art, including the holding of exhibitions and cultural events such as concerts and art exhibitions. The earmarked funds to tax-deferred awarding bodies or public corporations to acquire art works and art objects is one of the tasks of the Foundation. Furthermore, their portfolio includes the foundation of art prices and promoting heritage conservation in accordance with the law for the protection and maintenance of monuments in the former district Torgau-Oschatz. This is done through the provision of earmarked funds for the conservation and restoration of monuments.
9664_7	The Kunsthalle der Sparkasse Leipzig The Kunsthalle is located at one of the oldest savings bank locations in Leipzig. Acquired in 1914 by the Sparkasse, the building was its main location until the Second World War and its expropriation in 1950. Since 1994, it is again in possession of the Sparkasse, and it has been extensively renovated. The Kunsthalle has 352 m2 of exhibition space in the annex from 1924, right on the banks of the splices mill race and shows works from the collection of the Sparkasse Leipzig. With around 3000 exhibits of 150 artists who live and work in and around Leipzig, it holds the largest collection of "Leipzig School".
9664_8	Sparkasse Leipzig Museum The permanent exhibition of the Sparkasse Museum is divided into five chapters of the Leipziger Sparkasse history - from the first initiative of the Leipzig Sparkasse founder up to the financial service of the present. In the background it shows the social, economic and political developments of the 19th and 20th centuries. Visitors can see the first major book of Sparkasse Leipzig (1826-1838), one of the first armored safes from the mid-19th century, savings books and currencies from different eras, office machinery and equipment from the last century, and historical advertising among other things. References External links www.sparkasse-leipzig.de www.leipziger-medienstiftung.de www.kultur-und-umweltstiftung.de www.stiftung-torgau-oschatz.de Banks of Germany Companies based in Leipzig
9665_0	In psychology, the human mind is considered to be a cognitive miser due to the tendency of people to think and solve problems in simpler and less effortful ways rather than in more sophisticated and more effortful ways, regardless of intelligence. Just as a miser seeks to avoid spending money, the human mind often seeks to avoid spending cognitive effort. The cognitive miser theory is an umbrella theory of cognition that brings together previous research on heuristics and attributional biases to explain how and why people are cognitive misers. The term cognitive miser was first introduced by Susan Fiske and Shelley Taylor in 1984. It is an important concept in social cognition theory and has been influential in other social sciences including but not exclusive to economics and political science."People are limited in their capacity to process information, so they take shortcuts whenever they can."
9665_1	Assumption The metaphor of the cognitive miser assumes that the human mind is rather limited in time, knowledge, attention, and cognitive resources. Usually people do not think rationally or cautiously, but use cognitive shortcuts to make inferences and form judgments. These shortcuts include the use of schemas, scripts, stereotypes, and other simplified perceptual strategies instead of careful thinking. For example, people tend to make correspondent reasoning and are likely to believe that behaviors should be correlated to or representative of stable characteristics. Background
9665_2	The naïve scientist and attribution theory Before Fiske and Taylor's cognitive miser theory, the predominant model of social cognition was the naïve scientist. First proposed in 1958 by Fritz Heider in The Psychology of Interpersonal Relations, this theory holds that humans think and act with dispassionate rationality whilst engaging in detailed and nuanced thought processes for both complex and routine actions. In this way, humans were thought to think like scientists, albeit naïve ones, measuring and analyzing the world around them. Applying this framework to human thought processes, naïve scientists seek the consistency and stability that comes from a coherent view of the world and need for environmental control.
9665_3	In order to meet these needs, naïve scientists make attributions. Thus, attribution theory emerged from the study of the ways in which individuals assess causal relationships and mechanisms. Through the study of causal attributions, led by Harold Kelley and Bernard Weiner amongst others, social psychologists began to observe that subjects regularly demonstrate several attributional biases including but not limited to the fundamental attribution error. The study of attributions had two effects: it created further interest in testing the naive scientist and opened up a new wave of social psychology research that questioned its explanatory power. This second effect helped to lay the foundation for Fiske and Taylor's cognitive miser.
9665_4	Stereotypes According to Walter Lippmann's arguments in his classic book Public Opinions, people are not equipped to deal with complexity. Attempting to observe things freshly and in detail is mentally exhausting, especially among busy affairs. The term stereotype is thus introduced: people have to reconstruct the complex situation on a simpler model before they can cope with it, and the simpler model can be regarded as stereotype. Stereotypes are formed from the outside sources which identified with people's own interests and can be reinforced since people could be impressed by those facts that fit their philosophy.
9665_5	On the other hand, in Lippmann's view, people are told about the world before they see it. People's behavior is not based on direct and certain knowledge, but pictures made or given to them. Hence, influence from external factors are unneglectable in shaping people’s stereotypes. “The subtlest and most pervasive of all influences are those which create and maintain the repertory of stereotypes.” That is to say, people live in a second-handed world with mediated reality, where the simplified model for thinking (i.e. stereotypes) could be created and maintained by external forces. Lippmann therefore suggested that the public"cannot be wise", since they can be easily misled by overly simplified reality which is consistent with their pre-existing pictures in mind, and any disturbance of the existing stereotypes will seem like "an attack upon the foundation of the universe".
9665_6	Although Lippmann did not directly define the term cognitive miser, stereotypes have important functions in simplifying people's thinking process. As cognitive simplification, it is useful for realistic economic management, otherwise people will be overwhelmed by the complexity of the real rationales. Stereotype, as a phenomenon, has become a standard topic in sociology and social psychology.
9665_7	Heuristics Much of the cognitive miser theory is built upon work done on heuristics in judgment and decision-making, most notably Amos Tversky and Daniel Kahneman results published in a series of influential articles. Heuristics can be defined as the "judgmental shortcuts that generally get us where we need to go—and quickly—but at the cost of occasionally sending us off course." In their work, Kahneman and Tversky demonstrated that people rely upon different types of heuristics or mental short cuts in order to save time and mental energy. However, in relying upon heuristics instead of detailed analysis, like the information processing employed by Heider's naïve scientist, biased information processing is more likely to occur. Some of these heuristics include:
9665_8	representativeness heuristic (the inclination to assign specific attributes to an individual the more he/she matches the prototype of that group). availability heuristic (the inclination to judge the likelihood of something occurring because of the ease of thinking of examples of that event occurring) anchoring and adjustment heuristic (the inclination to overweight the importance and influence of an initial piece of information, and then adjusting one's answer away from this anchor). The frequency with which Kahneman and Tversky and other attribution researchers found the individuals employed mental shortcuts to make decisions and assessments laid important groundwork for the overarching idea that individuals and their minds act efficiently instead of analytically.
9665_9	The cognitive miser theory
9665_10	The wave of research on attributional biases done by Kahneman, Tversky and others effectively ended the dominance of Heider's naïve scientist within social psychology. Fiske and Taylor, building upon the prevalence of heuristics in human cognition, offered their theory of the cognitive miser. It is, in many ways, a unifying theory which suggests that humans engage in economically prudent thought processes, instead of acting like scientists who rationally weigh costs and benefits, test hypothesis, and update expectations based upon the results of the experiments that are our everyday actions. In other words, humans are more inclined to act as cognitive misers using mental short cuts to make assessments and decisions, about issues and ideas about which they know very little as well as issues of great salience. Fiske and Taylor argue that acting as cognitive misers is rational due to the sheer volume and intensity of information and stimuli humans intake Given the limited information
9665_11	processing capabilities of individuals, people are always trying to adopt strategies that simplify complex problems. Cognitive misers usually act in two ways: by ignoring part of the information to reduce their own cognitive load, or by overusing some kind of information to avoid finding more information.
9665_12	However, other psychologists also argue that the cognitively miserly tendency of humans is a primary reason why "humans are often less than rational". This view holds that evolution makes the brain's allocation and use of cognitive resources extremely embarrassing. The basic principle is to save mental energy as much as possible, even when it is required to "use your head". Unless the cognitive environment meets certain requirements, we will try to avoid thinking as much as possible. Implications The implications of this theory raise important questions about both cognition and human behavior. In addition to streamlining cognition in complicated, analytical tasks, cognitive misers are also at work when dealing with unfamiliar issues as well as issues of great importance.
9665_13	Politics Voting behavior in democracies are an arena in which the cognitive miser is at work. Acting as a cognitive miser should lead those with expertise in an area to more efficient information processing and streamlined decision making. However, as Lau and Redlawsk note, acting as cognitive miser who employs heuristics can have very different results for high-information and low-information voters. They write, "...cognitive heuristics are at times employed by almost all voters, and that they are particularly likely to be used when the choice situation facing voters is complex... heuristic use generally increases the probability of a correct vote by political experts but decreases the probability of a correct vote by novices." In democracies, where no vote is weighted more or less because of the expertise behind its casting, low-information voters, acting as cognitive misers, can have broad and potentially deleterious choices for a society.
9665_14	Economics Cognitive misers could also be one of the contributors to the prisoner's dilemma in gaming theory. To save cognitive energy, cognitive misers tend to assume that other people are similar to themselves. That is, habitual cooperators assume most of the others as cooperators, and habitual defectors assume most of the others as defectors. Since cooperators offer to play more often, and fellow cooperators will also more often accept their offer, the researchers arrived at the consensus that cooperators would have a higher expected payoff compared with defectors when certain boundary conditions are met.
9665_15	Mass Communication Lack of public support towards emerging techniques are commonly attributed to lack of relevant information and the low scientific literacy among the public. Known as the knowledge deficit model, this point of view is based on idealistic assumptions that education for science literacy could increase public support of science, and the focus of science communication should be increasing scientific understanding among lay public. However, the relationship between information and attitudes towards scientific issues are not empirically supported.
9665_16	Based on the assumption that human beings are cognitive misers and tend to minimize the cognitive costs, the concept of low-information rationality is introduced as an empirically grounded alternative in explaining decision making and attitude formation. Instead of in-depth understanding of scientific topics, people make decisions based on other shortcuts or heuristics such as ideological predistortions or cues from mass media, and therefore use only as much information as necessary. The less expertise citizens have on an issue initially, the more likely they will rely on these shortcuts.
9665_17	The cognitive miser theory thus has an implication for persuading: attitude formation is a competition between people's value systems and prepositions (or their own interpretive schemata) on a certain issue, and how public discourses frame it. Framing theory suggest that the same topic will result in different interpretations among audience, if the information is presented in different ways. Audiences' attitude change is closely connected with relabeling or re-framing the certain issue. In this sense, effective communication can be achieved if media provide audiences with cognitive shortcuts or heuristics that are resonate with underlying audience schemata.
9665_18	Risk Assessment The metaphor of cognitive misers could assist people in drawing lessons from risks, which is the possibility that an undesirable state of reality may occur. People apply a number of shortcuts or heuristics in making judgements about the likelihood of an event, because the rapid answers provided by heuristics are often right. Yet certain pitfalls may be neglected in these shortcuts. A practical example of cognitive misers' way of thinking in risk assessment of Deepwater Horizon explosion, is presented below.
9665_19	People have trouble in imagining how small failings can pile up to form a catastrophe; People tend to get accustomed to risk. Due to the seemingly smooth current situation, people unconsciously adjusted their acceptance of risk; People tend to over-express their faith and confidence to backup systems and safety devices; People regard complicated technical systems in line with complicated governing structures; If concerned with the certain issue, people tend to spread good news and hide bad news; People tend to think alike if they are in the same field (see also: echo chamber), regardless of whether they are supervising this project or not.
9665_20	Psychology The theory that human beings are cognitive misers, also shed light on the dual process theory in psychology. Dual process theory propose that there are two types of cognitive processes in human mind. Daniel Kahneman provided his insight that these two processes could be named as intuitive (or System 1) and reasoning (or System 2) respectively. When processing with System 1 which start automatically without control, people pay little or even no effort but can generate surprisingly complex patterns of ideas. When processing with System 2, people allocate attention to effortful mental activities required, and can construct thoughts in an orderly series of steps. These two cognitive processing systems are not separate and can have interactions with each other. Here is an example of how people's belief are formed under the dual process model in several steps:
9665_21	System 1 generates suggestions for System 2, with impressions, intuitions, intentions or feelings; If System 1's proposal is endorsed by System 2, those impressions and intuitions will turn into beliefs, and the sudden inspiration generated by System 1 will turn into voluntary actions; When everything goes smoothly (as is often the case), System 2 adopts the suggestions of System 1 with little or no modification. As a result, one will generally believe one's impressions and act on one's desires. However, it does not necessarily mean that cognitive misers process little on System 2. The "reasoning" process can be activated to help with the intuitions when: A question arises, but System 1 does not generate an answer; An event is detected to violate the model of world that System 1 maintains.
9665_22	Conflicts also exists in this dual-process. A brief example provided by Kahneman is that when we try not to stare at the oddly dressed couple at the neighboring table in a restaurant, our automatic reaction (System 1) makes us stare at them, but conflicts emerge as System 2 of processing tries to control this behavior. The dual processing system can produce cognitive illusions. System 1 always operates automatically, with our easiest shortcut but probably with error. System 2 may also have no clue to the error. Errors can be prevented only by enhanced monitoring of System 2, which costs a plethora of cognitive efforts. Limitations
9665_23	Omission of motivation The cognitive miser's theory, though explained cognitive processes that people tend to go through when making decisions, provide few hints on the role of motivation. In Fiske's subsequent researches, the omission of the role of "intent" in the metaphor of cognitive miser is recognized. Motivation does affect the activation and use of stereotypes and prejudices. Updates and later research Motivated tactician As mentioned above, people tend to use heuristic shortcuts when making decisions. But the problem remains that although these shortcuts could not compare to effortful thoughts in accuracy, people should have a certain parameter to help them adopt one of the most adequate shortcuts. Kruglanski proposed that people are combination of naïve scientists and cognitive misers: people are flexible social thinkers who choose between multiple cognitive strategies (i.e. speed/ease vs. accuracy/logic) based on their current goals, motives, and needs.
9665_24	Later models suggest that the cognitive miser and the naïve scientist create two poles of social cognition that are too monolithic. Instead, Fiske, Taylor, and Arie W. Kruglanski and other social psychologists offer an alternative explanation of social cognition: the motivated tactician. According to this theory, people employ either shortcuts or thoughtful analysis based upon the context and salience of a particular issue. In other words, this theory suggests that humans are, in fact, both naive scientists and cognitive misers. In this sense people are strategic instead of passively choosing the most effortless shortcuts when they allocate their cognitive efforts, and therefore they can decide to be naïve scientists or cognitive misers depending on their goals.
9665_25	Meaning seeker The meaning seeker theory reject both metaphors of human cognitive behaviors of cognitive miser and motivated tactician. Built within the framework of self-categorization, researchers believe that people employ categorical thinking to make sense of the social world. This kind of categorical thinking give meaning to social stimuli under adverse or difficult processing conditions. See also Bounded rationality Motivated reasoning Representativeness heuristic References Further reading Cognition Psychological theories
9666_0	Prior to the introduction of brain death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart-beating donors (NHBDs). Donors after brain death (DBD) (beating heart cadavers), however, led to better results as the organs were perfused with oxygenated blood until the point of perfusion and cooling at organ retrieval, and so NHBDs were generally no longer used except in Japan, where brain death was not legally, until very recently, or culturally recognized. However, a growing discrepancy between demand for organs and their availability from DBDs has led to a re-examination of using non-heart-beating donations, DCD (Donation after Circulatory Death, or Donation after Cardiac Death), and many centres are now using such donations to expand their potential pool of organs.
9666_1	Tissue donation (corneas, heart valves, skin, bone) has always been possible for NHBDs, and many centres now have established programmes for kidney transplants from such donors. A few centres have also moved into DCD liver and lung transplants. Many lessons have been learnt since the 1970s, and results from current DCDs transplants are comparable to transplants from DBDs. Maastricht classification Non-heart-beating donors are grouped by the Maastricht classification: developed at Maastricht in the Netherlands. in 1995 during the first International Workshop on Non-Heart‐Beating donors. Categories I, II, IV and V are termed uncontrolled and category III is controlled.
9666_2	As of yet, only tissues such as heart valves, skin and corneas can be taken from category I donors. Category II donors are patients who have had a witnessed cardiac arrest outside hospital, have cardiopulmonary resuscitation by CPR-trained providers commenced within 10 minutes but who cannot be successfully resuscitated. Category III donors are patients on intensive care units with nonsurvivable injuries who have treatment withdrawn; where such patients wished in life to be organ donors, the transplant team can attend at the time of treatment withdrawal and retrieve organs after cardiac arrest has occurred. Maastricht definitions were reevaluated after the 6th International Conference in Organ Donation held in Paris in 2013 and a consensus agreement of an established expert European Working Group on the definitions and terminology were standardized, and later the word "retrieved" (organ) was substituted for "recovered" throughout the text.
9666_3	Organs that can be used Kidneys can be used from category II donors, and all organs except the heart can potentially be used from category III, IV and V donors. An unsuccessful kidney recipient can remain on dialysis, unlike recipients of some other organs, meaning that a failure will not result in death. Kidneys from uncontrolled (category II) donors must be assessed with care as there is otherwise a high rate of failure. Many centres have protocols for formal viability assessment. Relatively few centres worldwide retrieve such kidneys, and leaders in this field include the transplant units in Maastricht (the Netherlands), Newcastle upon Tyne and Leicester (United Kingdom), Madrid and Barcelona (Spain), Pavia (Italy) and Washington, DC (United States).
9666_4	Livers and lungs for transplant can only be taken from controlled donors, and are still somewhat experimental as they have only been performed successfully in relatively few centres. In the United Kingdom, NHBD liver transplants are currently performed in Addenbrooke's Hospital Cambridge, Queen Elizabeth Hospital Birmingham, King's College Hospital London, St. James's University Hospital, Leeds, Newcastle upon Tyne and the Scottish Liver Transplant Unit in Edinburgh. In other countries such as Spain, currently up to one third of transplants are performed with NHBD. The International Meeting on Transplantation from Non-Heart-Beating Donors is organised in the UK every 2 years and brings together specialists in transplantation including transplant physicians, surgeons, fellows, nurses, coordinators, intensive care physicians, perfusion technicians, ethicists, and researchers interested in the aspects of retrieval, preservation and transplantation of DCD thoracic and abdominal organs and
9666_5	cells.
9666_6	Lectures are held by experts on the most challenging themes such as clinical outcomes of transplantation of controlled and uncontrolled DCD organs, progress made on machine perfusion of kidneys, livers, lungs and hearts and ethics and legal issues regarding donation after cardiac death. Procedure for uncontrolled donors Following declaration of death, cardiopulmonary resuscitation (CPR) is continued until the transplant team arrive. A stand-off period is observed after cessation of CPR to confirm that death has occurred; this is usually from 5 to 10 minutes in length and varies according to local protocols.
9666_7	Once the stand-off period has elapsed, a cut down is performed over the femoral artery, and a double-balloon triple-lumen (DBTL) catheter is inserted into the femoral artery and passed into the aorta. The balloons are inflated to occlude the aorta above and below the renal arteries (any donor blood specimens required can be taken before the top balloon is inflated). A pre-flush with streptokinase or another thrombolytic is given through the catheter, followed by 20 litres of cold kidney perfusion fluid; the opening of the lumen is between the balloons so that most of the flush and perfusion fluid goes into the kidneys. Another catheter is inserted into the femoral vein to allow venting of the fluid. Once full formal consent for organ donation has been obtained from relatives, and other necessary formalities such as identification of the deceased by the police and informing the Coroner (in the UK), the donor is taken to the operating room, and the kidneys and heart valves retrieved.
9666_8	Procedure for controlled donors If the liver or lungs are felt to be suitable for transplantation, then the donor is usually taken directly to the operating room after cardiac arrest, and a rapid retrieval operation is performed once a 10-minute stand-off period has elapsed. It seems this stand-off period has been reduced to as short as 75 seconds based on a recent article by the CBC. This is now causing an ethical debate as to whether physicians will declare death sooner than is currently required. This is similar to a normal multi-organ retrieval, but prioritises rapid cannulation, perfusion and cooling with ice, with dissection following later. If only the kidneys are suitable for retrieval, either rapid retrieval or cannulation with DBTL catheter can be used. Use of a DBTL catheter allows relatives of the deceased to see them after death, but the donor must be taken to the operating room as soon as possible.
9666_9	Category IV donors (who are already brain-stem dead), should either proceed as for a normal multi-organ retrieval – if this has already started – or should be managed as a category II or III as appropriate to the circumstances of cardiac arrest. Ethical issues Certain ethical issues are raised by NHBD transplantation such as administering drugs which do not benefit the donor, observance of the Dead-donor Rule, the decision-making surrounding resuscitation, the withdrawal of life-support, the respect for a dying patient and the dead body, as well as proper information for the family. In 2016 author Dale Gardiner issued a report called "How the UK Overcame the Ethical, Legal and Professional Challenges in Donation After Circulatory Death". Actions prior to consent
9666_10	In category II uncontrolled donors, the donor may die and the transplant team arrive before the donor's next-of-kin can be contacted. It is controversial whether cannulation and perfusion can be started in these circumstances. On one hand, it can be considered a violation of the potential donor's autonomy to cannulate before their in-life wishes are known. On the other hand, delay in cannulation may mean that a patient's strongly held wish to be donor cannot be respected. Many ethicists also feel that a doctor's duty of care to the still living outweighs any duty of care to the dead. The compromise reached is usually to cannulate if there is any evidence of a wish to donate (such as a donor card or registration as a donor) even in the absence of next-of-kin.
9666_11	For category III donors, treatment is being withdrawn from a living person, who will then die and become a donor. Important factors for assessment include A) that the decisions regarding nonsurvivable injuries are correct, B) continued treatment is futile and C) that withdrawal is in the patient's best interests be made completely independently of any consideration of suitability as an organ donor. Only after such decisions have been firmly made should a patient be considered as a potential organ donor. Although such treatment can be continued until the transplant team arrives, no additional treatment should be started to improve the organs—until the point of death, the patient should be treated exactly as any other dying patient.
9666_12	The standard recommendation to ensure this is to require a complete separation of the treatment and organ procurement teams. It is not, however, clear how complete this separation can be in those jurisdictions that require hospitals to report the names of candidates for organ donation to an Organ Procurement Organization (OPO) before life support has been withdrawn so that organ donation can be discussed with surrogates. This forces treating physicians to view their patients partly as potential organ donors, and even absent an OPO, it is unrealistic to think treating physicians are not aware of benefits to others of transplantation, and sometimes weigh this against the benefit of continued treatment to the patient. As one author puts it: "If the person in need of organ transplantation is younger, more attractive, or in some way more deserving than another critically ill patient"—and there are always such patients awaiting transplants—"then the conclusion that one patient's condition
9666_13	is hopeless can be tainted by an understanding of the tremendous hope organ availability holds for another."
9666_14	Factored into this is the element of judgement that physicians bring to evaluating the "best interest" of patients. There is considerable variability among physicians in determining from whom to withdraw life-sustaining treatments in the ICU. Bias has been demonstrated on the part of medical professionals against patients who are perceived as handicapped or are otherwise stigmatized. Studies have shown that, when evaluating the quality of life of severely handicapped patients, physicians consistently apply much poorer rating than do the patients themselves. This raises the question: Would prejudice about vulnerable patients, such as the handicapped, lead medical professionals to approach such individuals and families for NHBD more than others with higher "quality of life" ratings? Thus, as Doig puts it: "…the possibility of conflicted decision-making in a controlled DCD program is more than a theoretical possibility." The upshot is that the mere existence of a NHBD program in a
9666_15	hospital potentially compromises the care of patients. Few have rejected those programs on this basis, but the question of how to protect against it is ongoing.
9666_16	Dead donor rule The so-called "dead donor rule" (DDR) requires that persons be dead before their organs can be taken, and this rule is basic to all DCD programs. Also common to all DCD programs is that death is determined by cardiocirculatory criteria according to which life-support is withdrawn, an interval of the monitored absence of pulse, blood pressure, and respiration observed, and then death declared. Programs differ, however, on the length of the interval. The Pittsburgh Protocol requires 2 minutes, the Institute of Medicine (IOM) and Canadian Council for Donation and Transplantation (CCDT) 5 minutes, the 1981 President's Commission 10 minutes, and recently Boucek et al. have proposed that it can be shortened to 75 seconds.
9666_17	These times are based on estimates of when autoresuscitation (i.e., the spontaneous recovery of circulatory activity) becomes impossible. The scientific validity of all these times, however, has been questioned. The IOM in 2000 concluded that "existing empirical data cannot confirm or disprove a specific interval at which the cessation of cardiopulmonary function becomes irreversible." In addition, none of these intervals precludes the possibility of CPR restoring cardiocirculatory activity. To preclude that, brain death is required. The exact interval at which that occurs is likewise not known, but it is known to be more than 10 minutes.
9666_18	In light of this we can now raise the question of whether patients declared dead by cardiocirculatory criteria are really dead. It is generally agreed that death occurs when the patient is in an irreversible state. Whether patients declared dead by cardiocirculatory criteria are really dead thus depends on what is meant by "irreversible," and the term is open to a stronger and weaker interpretation.
9666_19	On the stronger interpretation "irreversibility" means that spontaneous cardiocirculation "cannot be restored no matter what intervention is done, including CPR." On the weaker interpretation it means that spontaneous cardiocirculation "cannot be restored because CPR efforts have been refused by the patient (as a DNR order in an advance directive), by a surrogate decision-maker or by the medical team because it is not medically indicated." Thus the person need not be in a physically irreversible state, but only in a morally or legally irreversible state.
9666_20	On the weaker interpretation, persons declared dead by DCD cardiocirculatory criteria cannot be known to be dead, as it is not always physically impossible to restore circulation by vigorous CPR. The weaker interpretation, however, does allow persons declared dead by DCD criteria to be counted as dead. It is often objected that this interpretation does not accord with the everyday meaning of death. Ordinarily we do not think that persons are dead when we have reasons not to revive them, but only when they cannot physically be revived. Nonetheless, declaring persons dead for purposes of transplantation by DCD criteria is "accepted medical practice" in many parts of the world, and where it is (as in Canada, for example) the legal standard for declaring death is met.
9666_21	The upshot is that we cannot straightforwardly say whether DCD violates the DDR. Whether it does or not depends on whether we think this requires that people be dead in the ordinary sense of the word or in a legal or some other understanding of it, and writers are lined up on both sides of this issue.
9666_22	Pain and suffering Controlled DCD may involve interventions such as vessel cannulation before life-sustaining therapy is withdrawn and death is declared, and may also involve post-mortem interventions such as in situ preservation. Uncontrolled DCD may additionally involve chest compressions and mechanical ventilation both before and after consent for DCD is obtained and typically requires the withdrawal of life-sustaining treatment. We know that all of these interventions cause distress to conscious patients who are not taking palliative medications. Thus, because patients who are candidates for DCD are not known to be brain dead either before or shortly after they are declared dead by cardiocirculatory criteria, the possibility that they may experience distress must be considered.
9666_23	There are 3 approaches that have been taken to this possibility of pain and suffering: (1) provide palliative medications where there are physical signs compatible with distress; (2) withhold all such medications on the ground that even if signs of distress are occurring, the patient does not have sufficient cognition to interpret any sensations as noxious; or (3) provide palliative medications prophylactically to prevent any possible distress. Whichever approach is adopted, worries have been expressed over whether patients can be guaranteed not to experience any distress. Re: (1) providing medication only on signs compatible with distress does not prevent the possibility of distress. Re: (2), since patients declared dead by cardiocirculatory criteria cannot be known to be brain dead, dismissing signs compatible with distress as not being distress again does not prevent the possibility of distress. Re: (3) physicians may inappropriately withhold sufficient sedative or analgesic
9666_24	medication to avoid the appearance of euthanasia or in order to improve organ viability.
9666_25	There is also the question of whether DCD patients receive compromised end of life (EOL) care. The President's Council for Bioethics has warned that DCD can transform EOL care from a "peaceful dignified death" into a profanely "high-tech death" experience for donors and donor's families. ICUs are not typically set up to provide optimum palliative care. The process of obtaining donation consent and subsequent donor management protocols for DCD deviate from some of the quality indicators recommended for optimal EOL care. Organ-focused behaviour by professionals requesting consent for organ donation and ambivalent decision making by family members increase the risk of relatives of deceased donors subsequently developing traumatic memories and stress disorders. The processes required for the successful accomplishment of donation consent and subsequent organ recovery can interfere with many of the interventions that lessen the burden of bereavement of relatives of ICU decedents.
9666_26	Informed consent What are donors told about death and pain in order that they can give informed consent?
9666_27	The standard consent for DCD goes like this. Patients or families are told that they will have a chance to say their goodbyes, the patient will then be taken to the operating room, life support will be removed, and after 2–10 minutes of continuously observed absence of pulse, blood pressure, and respiration, death will be declared and the removal of organs begin. Consent to this is taken to be consent to organ donation at death determined by cardiocirculatory criteria, i.e., to DCD. The problem is that death is commonly understood as an irreversible state in the strong sense. The commonsense understanding of death is that it is a permanent state, and that if a person has truly died then life cannot be restored to the individual. Death understood as an irreversible state in the weak sense—as one that will not be, or ought not to be, or cannot legally or morally be reversed—is on this view a revisionist account of how death can be best conceived rather than an accurate descriptive
9666_28	account of how it actually is commonly understood. Given this, when donors consent to donation at death they can only be presumed to be consenting to organ donation when their loved one is in a physically irreversible state. Since, however, death determined by cardiocirculatory criteria is not necessarily a physically irreversible state, consent to organ donation at death is not consent to organ donation at death determined by cardiocirculatory criteria.
9666_29	Menikoff criticizes the IOM for not routinely disclosing to prospective donors and families that and how death determined by cardiocirculatory criteria differs from death in the ordinary sense. In particular, he faults the IOM for not telling them that donors will be declared dead before brain death is known to have occurred, and hence they may have their organs removed when portions of the brain (including the higher brain) are still functional. Potts et al. on behalf of the IOM reply that informed consent does not require this level of disclosure: "Reviewing with interested family members that all brain activity may not have ceased at the exact moment that death is pronounced may be appropriate in some circumstances, but, for many families confronted with such overwhelming emotional matters, knowledge that death has been pronounced is what is paramount. The sensitivity and skill of the physicians and nurses to the individual needs of families is the key factor whether or not
9666_30	organ donation is involved."
9666_31	Behind this disagreement on what disclosure is required is a larger one that Brock has characterized as a choice between "truth or consequences". In Brock's view, public policy cannot centre in on the unqualified and unconstrained search for the truth without concern for the consequences of that search. On some occasions "the likely effects on the well-being and rights of the public of exposing the full complexity, ambiguity, uncertainty, and controversy surrounding a particular public policy could be sufficiently adverse and serious to justify not exposing them and presenting the issue in misleading or oversimplified terms instead." Brock concludes that "No general answer can be given to truth-or-consequences choices that will hold for all cases. In any particular instance of this choice, we must instead weigh the policy gains against the moral and political risks, and how that balances out will often be empirically uncertain and morally controversial."
9666_32	On the issue at hand, Menikoff and Brock think that the importance of informed consent should put us on the "truth" side of the question. Menikoff writes: "Deceiving prospective organ donors about relevant truths concerning their condition is likely, ultimately, to lead to diminished public confidence and to fewer organ donations. But even if it did not reduce the number of donated organs, in a system that is allegedly based on freely given consent, we must recognize that obtaining such consent by telling less than the truth is fundamentally wrong." And Brock contends that in a democratic state there is a presumption that the citizens will be informed about all relevant information of public policy, and thinks that DCD involves such a radical change in the timing of death from what people ordinarily think, that it is something that they should be informed about. By contrast, the IOM took itself to have the task of addressing the question: "Given a potential donor in an
9666_33	end-of-life situation, what are the alternative medical approaches that can be used to maximize the availability of organs from that donor without violating prevailing ethical norms regarding the rights and welfare of donors?" And it replied: "Our goal was to support both the interests of patients and families regarding nature and time of death and the public's interests in increased organ procurement. In striking the balance, the expert panel strictly adhered to widely endorsed principles of ethics and established legal and legal guidelines." In thus balancing what is disclosed to the family against what is in the interest of organ procurement, the IOM comes down on the "consequences" side of the "truth or consequences" debate.

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